There are certain points about the Care Act and NHS Continuing Healthcare that you need to be aware of.

Elements of the new Care Act come into effect in England on 1st April 2015. The remainder was due to come into effect in 2016*. (*See update at the end of this article.)

This article is not a detailed overview of the Care Act. Instead, it raises just a few of the points that families may need to be aware of in the first instance. We’ll look at other points in future articles.

The most important point to be aware of about the Care Act and NHS Continuing Healthcare is that:

the new Care Act does not change the rules about NHS Continuing Healthcare – or who it applies to.

That the new Care Act abolishes NHS Continuing Healthcare funding. It does not.

That all care will now be means tested, including NHS Continuing Healthcare. It is not. NHS Continuing Healthcare is not means tested.

That the new Care Act does away with the above distinction between social care and healthcare funding. It does not.

That people receiving NHS Continuing Healthcare now have to pay for their social care. They don’t.

Self-funders and the Care Act

If you don’t qualify for NHS Continuing Healthcare funding (or if you have Continuing Healthcare funding removed at some point) it means that your care needs are deemed to be social care needs. This means the Care Act becomes relevant to you at that point – because the Care Act is largely about social care.

‘Self-funders’ – the term used to describe people who pay for their own care – have had a pretty raw deal in the past. They’ve generally been invisible to the wider health and social care system and have been left to fend for themselves, paying the highest fees for care and having little – if any – access to advice or contact from the local authority.

With the Care Act, self-funders will at least now be on the radar of the local authority. The local authority must now calculate the cost of a person’s care – and keep a record of these calculations (a care account) – regardless of how much money a person has. This is because from April 2016* a new care fees ‘cap’ was due to come into effect. (*See the latest update on this at the end of this article.)

The ‘cap’ on care fees

Vital point:

The much publicised cap on care fees applies only to social care (means tested care).

It was due to start coming into effect from April 2016*. (*See the latest update on this at the end of this article.) The idea behind the cap is to limit the amount that any one individual over the age of 25 has to pay in total for their care to £72,000. In practice, however, few people (probably only one in eight people) will actually benefit because:

the cap only covers actual care costs, not living costs or accommodation costs in a care home

the average stay in a care home is between two and three years, many people will never reach the cap, but will instead have to pay for everything

the cost of actual care is calculated only at the rate the local authority is prepared to pay; very often this does not cover the actual cost of care.

For example, a self-funder could be paying £800/week in care fees, and yet if the local authority rate is only £500/week, it means only £500/week will be included in the care account – BUT living costs will also be deducted from this. These living costs are nominally calculated at £230 per week (approx. £12,000/year), and so in this example only £270 would actually count towards the cap (£500 less £230).

It’s easy to see that, by the time a person reaches the cap, they may have paid a great deal more than £72,000.

So, in essence, the lower the local authority rate, the less is included in any care account, and so the longer it will take a person’s total care costs to accumulate to reach the cap.

In the meantime they will have to pay the full cost of their care – and even when they reach the cap they will still have to continue to pay all living costs and all costs of accommodation in a care home. If a person can’t pay this, the local authority will help.

How will social care care needs be assessed under the new system?

There will be a new system of social care assessments, and this is a contentious point about the new Care Act. In many people’s views, the proposed system leaves scope for a high degree of both subjectivity and error on the part of the assessor.

But remember – and this is a vital point in relation to NHS Continuing Healthcare – if a person has care needs that are beyond the local authority’s legal remit for care provision, the NHS should still provide and pay for all care – with no means testing. NHS Continuing Healthcare funding is not affected.

If a person is receiving NHS Continuing Healthcare funding, the cap is not directly relevant to them while they are receiving that funding. There should also be no cap on NHS Continuing Healthcare funding, despite some Clinical Commissioning Groups incorrectly now trying to impose one.

A person who is awarded Continuing Healthcare funding may have previously been self-funding, and from April 2016* onwards (*see the note at the end of this article) any self-funded payments (for actual care) were due to be recorded and count towards the cap.

A person currently receiving Continuing Healthcare funding may, at some point, have that funding taken away and be deemed as needing only social care. If this happens, and if it’s justified in being removed, and the person becomes self-funding, their payments for care will of course count towards the cap.

Given the significant extra workload that will land at a local authority’s door with these new assessments, it’s important for self-funders to make contact with the local authority sooner rather than later, to be assessed from October 2015 onwards – in time for a ‘care account’ to be set up by April 2016*. (*See update at the end of this article.)

New social care assessments

Here’s the controversial bit:

The amount a person may need to pay for their social care will hinge on what scores or comments one sole assessor decides to put on an assessment form. The amount of care that will count towards the cap will be only those needs that the assessor actually records and decides are ‘eligible’ needs.

If care needs get overlooked or missed out, the person being assessed will end up with a lower ‘estimated budget’, there will be less recorded in their care account, they will pay more out of their own money and they will take longer to reach the cap.

Just like with NHS Continuing Healthcare, these new social care assessments are about care needs only; they should not be an assessment of a person’s money.

It is likely that local authorities will outsource the assessment of self-funders’ care needs to a third party. In this there is a risk that the companies doing such care assessments may not have the skills and knowledge to properly assess needs. (And remember this is an assessment of care needs, not money.)

Such assessments and/or reassessments could even be done over the phone, again allowing scope for grave error in determining a person’s actual level of need.

Also, in any new social care assessment, the assessor MUST take account of potential eligibility for Continuing Healthcare. However, many people fear that the people carrying out these tick-box social care assessments won’t have the knowledge or experience to understand what actually constitutes eligibility for NHS Continuing Healthcare.

It means a box could be ticked to say Continuing Healthcare has been considered and discounted, when in fact the assessor has not properly evaluated the criteria in the Continuing Healthcare Checklist at all.

There would seem huge scope for error here. And it would seem unlikely that any proper consideration of Continuing Healthcare eligibility could possibly be made if a self-funder is just asked a few questions over the phone by someone without professional knowledge of the person’s health and nursing care needs.

Before reaching the new social care cap

Before a person reaches the social care cap, and assuming they have money and/or assets above the means test threshold, they will pay for all of their care.

Again, this does not apply to NHS Continuing Healthcare – which is not means tested.

No care costs paid before April 2016* will count towards the cap. (*See the update at the end of this article.)

Top-up fees will not count towards the cap.

Any other services that are not in the original social care assessment of eligible needs will not count towards the cap.

Interest charged by local authorities on deferred payment arrangements (see below) will not count towards the cap.

Financial help provided by the local authority towards actual care costs will count towards the cap.

As with Continuing Healthcare, families will need to be vigilant to ensure that their relatives are being properly assessed and that all care needs are taken into account. The number of appeals is expected to be high.

New means test thresholds from April 2016

Once a person has reached the cap, i.e. they have paid £72,000 for their actual care (excluding living costs), the local authority will provide funding based on a means test. The individual will still be responsible for paying for accommodation, general living costs, etc. – and, if applicable, care fees top up payments will still need to be paid by someone other than the local authority.

Separately from the care fees cap, new thresholds for means tested care were due to come into effect in April 2016*. (*See update at the end of this article.) Essentially:

if property is included in the value of a person’s money and assets, the new upper means test threshold will be £118,000 (currently £23,250), i.e. anyone will money above this level will pay for all of their care

if property is disregarded (for example if a spouse still lives there), the upper threshold will be £27,000, and means tested support will be available from the local authority

the new lower threshold (below which a person contributes only from their income, not their capital) will be £17,000 (currently £14,250).

Your care costs will be recorded in your care account regardless of how much money you have and regardless of any means test threshold. This care account is the amount you’re paying for your actual care that counts towards the cap.

Universal deferred payment schemes

These deferred payment arrangements are designed to give people a choice about whether or not to sell their home to pay for care. A person can put off the sale and the local authority will cover care costs in the meantime and then recoup costs from the sale of the property later on.

These arrangements will continue but now a local authority will charge interest (at 2.65% p.a.) and the agreements will only apply to people who have already used up their other money and savings down to the upper means test limit (currently £23,250, from April 2016 £27,000).

The local authority will also be able to levy an admin charge for such arrangements. A local authority must offer a deferred payment arrangement if a person has no other funds with which to pay for care.

Deliberate deprivation of assets

The restrictions on deliberately giving away or hiding money to avoid care fees will still apply, and it’s vital to take good independent financial advice before doing anything. People will still be able to make certain gifts under inheritance tax rules.

Hospital discharge and NHS Continuing Healthcare

One of the most common problems people encounter when being discharged from hospital and needing ongoing care is that members of hospital discharge team often seem very keen to find out about a patient’s money – and yet the focus should be on the patient’s ongoing care needs – not their money.

No one should be asking about a patient’s money until it has been clearly shown who is responsible for paying for any ongoing care – based on care needs only.

The Care Act requires the NHS to notify a local authority if a person being discharged from hospital is likely to require ongoing care and support. This is called a ‘notice’ or ‘assessment notice’, i.e. a hospital is giving the local authority notice that there are ongoing care needs for which provision needs to be made.

“Before issuing an assessment notice, the NHS body must have also completed any assessment of the potential Continuing Health Care needs of the patient and if applicable made a decision on what services the NHS will be providing.”

Annex H5 of this same guidance covers more about NHS Continuing Healthcare funding.

The Care Act and NHS Continuing Healthcare

Remember…

Given that many people in the care sector – both within local authorities and the NHS and also professional advisers – and focused heavily on the Care Act at the moment, NHS Continuing Healthcare could get forgotten when families are told about care funding.

Remember these three points:

the Care Act does not change NHS Continuing Healthcare

a person needing full time care who has health needs should still be assessed for Continuing Healthcare before they pay a penny in care fees

on discharge from hospital a person should be assessed for Continuing Healthcare funding

All the current talk about the Care Act in the press and by people in health and social care could mislead people into thinking that all care is social care – and that all care is means tested. This is not the case.

NHS Continuing Healthcare is still provided by the NHS and it is not means tested – and it has nothing to do with a person’s savings or property. It is provided and funded by the NHS regardless of a person’s means. The Care Act does not change this.

Remember also that if a person is eligible for NHS Continuing Healthcare, the NHS funding that follows should not only cover their healthcare and nursing care needs, but also that person’s social care needs.

38 Comments

Unfortunately Social Workers are using the Care Act to say that the care a person is receiving is their jurisdiction – The Care Act states that the Local Authority is responsible for a person’s PHYSICAL, EMOTIONAL & MENTAL WELL BEING – How is it possible to challenge that please. How can you identify what is outside of their remit? Thank you

Hi Glynis
This isn’t very difficult as my mum in a similar situation. If you get social care to do the Checklist they will then seen if it triggers the Decision Support Tool used for Continuing Healthcare funding. I think looking at the National Framework for NHS Care they have a responsibility for illness and preventing illness so I tend to look at my mum’s health and deterioration of it e.g lack of mobility, choking, incontinence to look at what illnesses should be prevents and what ones are present, such as pressure sores, skin needing barrier cream, chest infections etc. Hope that helps. Look at the complexity of the care & how many carers she needs.

Hi this is not a reply to specific comment but not sure how to get my question on here. My Mum was given chf prior to discharge from hospital to care home this year. We had the 3 month review carried out by a contracted assessor appointed by chc in August.
The assessor during the meeting indicated that she disagreed with the original decision to award funding to my mum ( has alzheimers & breast cancer and had broken foot) and at end of meeting would not say what recommendation she was going to make to the health authority. I said that her attitude and comments indicated that she seemed to be trying to say that Mum’ s needs were social not health and I said if that was the case than she should have had a social worker at the meeting and she seemed to agree that this might be the case. I still have not heard what the decision on Mum’s funding going forward is. I have not chased ( not sure if should) as until they give a decision it seems care will be paid in meantime. However, she is now in a different area to where she lived so in the event that social care needed to be involved in funding in future would this still fall under remit of social services from where she lived when the original decision was made( as the chf stays with the original commissioning group) or would social services in the new area where the home is take over instead?

Thank you for your informative website. I keep reading comments you have made to others about how no-one should be asked to pay for their own care until after a full assessment for CHC has determined whether the NHS or social services is responsible. You also say that if local authorities means test for care before the CHC assessment they may be acting illegally. I would welcome your comments on my father’s situation.
We first came into contact with a social worker (part of a community mental health team) when Dad was discharged from hospital in January – she phoned in March saying she’d only just got in touch as she hadn’t known my father had been discharged. She mentioned a financial assessment. I refused. Since then there has been another hospital stay and my fathers’s Alzheimers/mental health has made him very difficult to care for. He lives with my mum and as neither are safe unless he is supervised family(mainly my sister) have effectively been providing 7 days a week care as my father doesn’t want to go to a care home. We have not managed to find any support services to help us with keeping him at home (other than a day centre) and as the community mental health team refer to us as self funders our only option has been private care agencies and they haven’t really been up to the job/able to do what we need. We have paid some carers, my sister and other family members however have provided and continue to provide the vast majority of care for free and we have funded a respite week in a care home. Should we be paying for all this/any of this? My sister gave up her business and I turned down a renewal of my contract as we were unable to work and care for mum and dad. No CHC assessment was carried out when dad was discharged, a social workers told us Dad wouldn’t pass the Checklist when I mentioned it in April and every time we speak to someone new from the mental health team they bring up the importance of a financial assessment. I finally got a Checklist completed this month but the mental health team are refusing to refer it to the CCG because of a medication change they believe may have an effect on his behaviour. The worrying comment for me after it has taken 9 months to get a Checklist completed is that they will decide IF/WHEN the Checklist needs re-doing in 8 weeks time. The implication is that a new Checklist will be needed and they – not we – will decide whether or not to do one.
I would welcome your comments.
Thanks,
Meggie

My mum was in a care home but is now in hospital after several falls and we are told now requires nursing home care. We are pretty certain she will be eligible for NHS Continuing Healthcare and should this be the case is there a limit to what the NHS will pay for a nursing home and would we be able to choose which nursing home she resides in? We haven’t applied or mentioned NHS CHC to the social worker that has been assigned to mum but she has told us mum will be offered a Local Authority Nursing Home and we will need a really good reason if we turned it down. If mum got NHS CHC would the social worker be correct in what she has told us or can we choose a nursing home of our choice? Many thanks.

In response to John’s question “is there a limit to what NHS will pay for in a nursing home”? My very recent 2018 experience in Wales is a resounding YES! And the tactics CHC use in my mums case is below:
1) My mother was found eligible for NHS Continuing Healthcare (CHC) (after a terrific battle). Following this, we were categorically told several times by the CHC, and the care home was told in writing, that the costs of her care would be covered IN FULL. CHC knew the care home she was going to – the only one available – and we had checked with their representative at the discharge meeting that this was acceptable care home “on their list”. It was. In short, the amount CHC will pay to cover her care is significantly lower than the – standard level – care home fees (which were already known to the CHC). My mother was already at the home at this point, leaving us the family to foot a large shortfall unexpectedly (very stressful, also illegal) and appeal if CHC don’t behave.

2) The care home manager addressed this with CHC and they agreed send an assessor to assess my mother for the “extra fees” above the arbitrary amount CHC decided they would pay. This seemed an odd solution, but we went with it. We have since found out that the “assessment” is not for this purpose, but to review her eligibility for CHC entirely. After a only a month!

Just wanted to flag up these practices. Any advice -beyond having to take the CHC to court for not covering the cost of care in full – much appreciated.

My bedbound 86 yr old frail mom was on Continuing Healthcare (CHC) and she moved for respite to a nursing home which she paid as a self funder over £700 p.W. Social workers in our new area said we couldn’t take mom back and care for her at home unless a BEST INTERESTS meeting was done. Mom eventually came to live in our home so we could care for her, and now our care package of 2 carers 4 times a day is well over £700 – (over £800 bank hols). Why has my mom lost her right to CHC when she is much deteriorated and was put on Palliative Register Nov 2015. Also, doctors said mom has some sort of cancer in her tummy and a liver dysfunction, she also suffers dementia and vaso vagul attacks and is completely bedbound. In Wales before we moved Mom her care package was costing just £60 per week. Why the big difference now?

Lynette – later reply, sorry. The information we publish at Care To Be Different covers England only, as the system in Wales is different. That could explain the difference. However, if she moved from Wales to England, she should have been immediately (re)assessed for Continuing Healthcare, rather than just simply told to pay.

My father is in a care home. Up till March 2015 he has been paying his own fees. His savings have reduced. So the Council will pay £475.93. The care home fees are £575 per week. My mother has been told she must pay the top up fee of £99.07. My mother has no savings just her pension. I have been in contact with the social worker and I have said that this would put my mother into finaciial hardship and below the poverty line. It took my father a long time to settle. He is very happy as we are I got an email today. My mother has to pay the top up. If she does not, my father will have to move. The home has not been payed since March. The Council will not pay the fees till my mother pays the top up. What can we do?

Ann, it is illegal to charge a top up to a spouse in most circumstances. (if you were perhaps a multi millionaire then you could logically contract for life to do that). Otherwise, do not pay it. In fact in 2009 our councils helpful CHC/Adult care booklet stated that fact and in revisions it has, (deliberate dirty trick), disappeared. Although it was confirmed at a June 2015 IRP appeal as still being the case.

1. My daughter is in the process of undergoing a full CHC assessment the local council have insisted on undertaking a financial assessment prior to knowing the outcome of the full CHC assessment – are they able to do this?

2. If my daughter is given a jointly funded pot are the council still able to apply their charging policy which states that they will take all of my daughters income over income support plus 25%. In effect this will mean she is having to pay over her ESA and disability allowance to pay for her care as she has no savings or assists this clearly will leave her in poverty for life.

Hi Janet – thanks for your comment. Regarding the outcome of the CHC assessment process, it’s not possible for anyone to tell your daughter to pay for care until it’s been properly shown that she is a local authority responsibility – is indeed she is. If she’s told to pay before the local authority (as part of the CHC Multidisciplinary Team) has looked at whether her care needs are beyond simply social care, this potentially puts the local authority in an unlawful position. No one should be asking for financial information at this point. For more information about local authority charging, you may find this AgeUK link helpful: http://www.ageuk.org.uk/Documents/EN-GB/Factsheets/FS10_Paying_for_permanent_residential_care_fcs.pdf?dtrk=true%5D

My Aunt (who has no children of her own and has asked me to assist her) , has recently been diagnosed as end of life care with only a short time left . She is currently in hospital awaiting discharge she has been granted CHC funding as nursing care. They are suggesting a care home some distance away although there are several homes much nearer that can meant her needs , the distance will make it very difficult for her family to visit her and the nearer homes would be much easier for us all and are also in the area my aunts home is . I feel her emotional well being is not being considered is this sufficient grounds to challenge and ask them to meet the additional funding for a nearer home . The additional cost is not great and I feel it is reasonable given the short term consideration .

I can understand your feelings about the suggested care home, Chris, and that suggestion could potentially be motivated by cost. I agree with you that your aunt’s emotional wellbeing is also very important here and I would certainly challenge the choice you’ve been offered.

Can someone please help? My Mother (now 91) was diagnosed with vascular dementia some three years ago after an operation where she suffered a series of strokes. She went into a care home (self funding) as it was deemed impossible for her to go home. Two years ago she also qualified for nursing care. After yet another fall she has been in hospital for 5 weeks, the later two weeks in a ready to discharge state. The home she was living in has advised us that they can no longer meet her needs. After a meeting with the Complex Discharge Nurse we were told that she felt Mum now qualified for CHC and we went over the forms she had prepared adding any extra information we felt relevant. We left with a list of homes that she felt would be worth looking at. 5 days later we were informed that CHC had been given in principal but that the care home we had favoured felt they could not meet Mums needs at the current time (they only had a shared room available and because of Mums ‘challenging behaviour’). I was informed that the CHC would have to be re-addressed when another suitable home was found. So yesterday I visited another care home they had recommended. All went well and they certainly seemed to understand the needs of Mum and would be happy to take her subject obviously to assessment. It was an ‘interim’ bed which I was assured would probably turn into a permanent one after the 6 weeks.(By the way this ‘interim’ meant nothing to me – all I was told was that it was for people coming out of hospital). The minute I mentioned Mum had met CHC funding the manager said that this was a problem as they only dealt with placements through Social Services! I am so confused. We have had no communication with SS – do the two services not knit together? It seems so difficult to find a suitable home – I have been told to look for EMI but these seem so few and far between. Can I look at homes outside the council she comes under? I would like her to be a little closer to me in distance or between my brother and I (70 miles apart). Can someone please advise and explain our rights in plain terms? All we want is to get Mum out of hospital and get her the right care that she deserves.

The type of care home shouldn’t affect CHC eligibility or provision. There is a financial conflict of interest when it comes to CHC and care homes: a care home will receive more money from a self funder than from someone receiving CHC, and some families find that a care home can be reluctant to help with CHC funding assessments. However, normally a care home would receive more money in CHC payments than they would from Social Services (local authority payments), so it seems strange that you had the response you did from the manager. If there are no care homes in your area that can meet your mum’s care needs, then funding must be provided for a care home that can, even if it’s outside the area. Keep in mind at all times that CHC funding comes from the NHS – not the local council/local authority. If your mum has been awarded CHC funding, it’s the NHS that should be paying.

There is a problem with CHC in that even though the person who is totally Immobile she/he is not entitled to a motability vehicle even though this is the only method they have from leaving the nursing home. On the other hand if they are funded by Social Services the vehicle is available. It is also a fact that only the patients savings can be taken into account.

Clare,
It does seem awfully wrong that within my father-in-law’s home there are numerous full paying self funders and others that are jointly funded at a lower price with the assistance of the LA.

I seem to remember figures I had seen: Something like £1050 per week for self funders, £700 per week for NHS CHC, £550+ per week for LA joint funders. Even with £112 per week nursing care funding paid by the NHS the last figure is still around £50 short of what the NHS pays.

I believe that it is possible to get the LA to assist and obtain services at a similar price that they negotiate with homes, for a fully self funder, even if they have considerably more cash and assets than £25,000 or so. It might be possible to get the LA to pay the home at their negotiated rate and recharge you if they do not currently automatically do that.

However, if the cost of the home is considerably greater than the LA normally funds then of course there might be some difficulty.

I don’t understand why, with CHC, motability would be unavailable? That surely is part of the PIP and has nothing to do with CHC or Social Services funding? Perhaps it is to do with whether somebody has residential care as opposed to home care which is available with both, CHC and Social Care personal budget?

Additional earlier comment from Clare
31/03/2015
Having read the article, I still see that nothing much has really changed, it is just the usual re-hashed how can we screw the self funders and legally get away with it. I have no issue with people having to self fund but NOBODY will ever respond to my question of why self funders have to pay considerably more and subsidise the non payers. Would someone please explain this to me or maybe some of the so called “Champions of care fees and elderly care” at least have the decency to raise the question when next at one of their quangos. Would be really nice to see some of these well paid people actually asking the questions that really matter!!

I would caution all, that this act is also a smokescreen for giving the L.A responsibility to “look after” the carers of the sick, in similar ways to those that are currently being cared for.

This is a cynical attempt to discover how much cash and assets that YOU the carer might have or even have to come later.
It is the case that previously, the L.A unlawfully, (it is a data processing act offence to process data unnecessarily), and sneakily asked that carers completed financial assessment forms that closely mirrored those that were actually required so that they could assist a person that needed social care.

If at any time you require even minor and inexpensive assistance for yourself from the L.A, you will likely leave all of your finances wide open to their scrutiny and they can be recorded forever.

Imagine. My 76 year old dad: He looked after my 75 year old mum. The L.A needed her financial data so they could, according to her means, legally recharge her for their assistance.

If they had dad’s data too…… In what?…. Ten years, twenty years…… he asks for help…… They will be able to extrapolate all of his past state, private and occupational pensions and compare them with what he declares at the future time. They will be able to add in the value of his home. If he, at this time, has other savings and bank accounts then they will know that too.

That is when the investigations start….. “What did you do with your house 15 years ago?” “How much did you get for it?” “You moved in with your son, where did the cash go?”
“Where are all of your other savings?” …… “What did you buy with them?” ….. “Who did you gift them to?” …… There are loads more examples.
“You paid for a lavish wedding/University tuition and accommodation, for your granddaughter twelve years ago!” …… “Well, if you can’t pay it to us then we will get that money back from her then!”

Then again…. If mum had transferred him an asset upon her later death, or another will was paid out in his favour they could know about that too at the time that he actually does need their help and when before requiring the L.A’s help, and in good faith, he might have long distributed what he had been bequeathed.

Interesting food for thought, Chris. Thanks for your comment. I think that a very real risk. I suspect many families will assume that the social care assessment is a financial assessment – when in fact it should be, first and foremost, an assessment of need. I can’t help thinking that people will be asked about their money at the same time though, and they’ll be none the wiser.

Can someone help me, my father had end stage COPD and was admitted to hospital in August, in September he was transferred to a primary care hospital. He required full assistance getting to the bathroom and showering etc… he was assessed by the Social Worker and Nurses and was advised he needed to be transferred to a Nursing Home, in the meantime his health deteriorated and he was transferred back to the main hospital. I was then recommended by a new social worker at the main hospital to a new nursing home, which on Christmas Eve he was transferred to (mainly as the hospital wanted the bed!). He died in February. I completed the forms sent by the Local Authority with regards his pension etc… they claim not to have received them, I am now being chased by the new care home to pay for his care. If I have read the above article correctly, do I need to complete any forms to the Local Authority as it was professional medical care that he required? I am totally confused.

Did your loved one’s doctors give any indication that they feared that he would shortly die? Sorry this is hard to write without using a blunt pen.

If they did then his Doctors should have used the National Framework’s “Fast Track” procedure and so ensured that he was CHC funded until the NHS actually carried out a CHC assessment or in the interim, he died.

Regardless of that. It would appear to any normal person that his care needs were well beyond those that a L.A were permitted to pay and recharge for. Perhaps you should make that point and refuse to pay any demand by the L.A until such time as a CHC assessment is carried out against the evidence of needs that has already accrued.

I would argue that someone in authority should have done a checklist or even a CHC assessment if no one actually had.

I’m sad to hear that your father passed away, Angela. The first thing that should have been done when he went into the care home was an assessment for NHS Continuing Healthcare. That’s the only way to know who is actually responsible for paying for care – and there should be no means testing before this has been done. So it begs the question on what grounds the care home are asking for money. There has been no assessment process to conclude that your father had to pay for his care. It was the NHS’s responsibility to assess your father, and the local authority also had a duty to flag up that he may have been eligible for NHS funding. So the demands for money are highly questionable if none of this was done.

My husband has been assessed for fully funded Nhs Continuing care.
He has been in hospital over 10weeks and suffers from many different health issues as well as vascular dementia, which is unpredictable and changes on a daily basis. He had the checklist carried out without my knowledge and I was only told afterwards that he scored enough for a full assessment to be done.I was asked that time to sit down with the assessor and to add a page of my own as to his needs.I was asked to go over the results with the assessor and any points I disagreed with I was asked to put in my summary.I was concerned that the assessor didn’t know my husband or his needs. She told me that the social worker would also be involved and would give their view as well as his notes and the Doctors view would also be taken into account. I was asked to provide my views the following day, so I went online, purchased and downloaded your book. After reading it I realised that it seemed as if some things were not done properly in the assessment so I prepared to do battle. To my shock the assessor told me of her recommendation which was for fully funded Nhs continuing care. She also said the social worker and the consultant had also recommended full funding. She hoped to a get a response from the CCG within a couple of weeks but I should look at Nursing homes with a Dementia unit to be prepared to give my preference. This was all 3weeks ago and I have heard nothing other than the assessor telling me my 1st choice (although stating on their website they accepted Nhs continuing care patients) would be too expensive than they would
be prepared to pay and so would I be prepared to pay the balance to ‘top up’ the amount the Nhs would pay? I didn’t really answer just said I didn’t think I should make any decisions until I know if he has Continuing care or not. I understood that ‘topping -up’ wasn’t possible. It was either you got the full funding or not? Can you confirm? Thank you.

Given the haphazard way in which the assessment was carried out, it’s interesting that CHC was recommended. They should have given you adequate notice of a multidisciplinary team assessment, and it should have been a comprehensive discussion and review of care needs – by people who know and understand your husband’s needs. You’re quite correct that you can’t top up NHS funding – not should you be asked to. This seems on the face of it to be an attempt by the NHS to avoid providing the funding it may have a legal duty to provide.

My wife has had full CHC funding for two years ….at a recent CHC review we lost it..we are now on what they call a shared package between LA and NHS..Her health needs which the NHS pays for(12 hours a day)… will we be means tested on the portion that the LA are contributing or will we be stung for the lot..?

You should never be means tested for any NHS care – so for that element of the care package your wife’s money/assets are entirely irrelevant. However, an equally important issue is why they took away full CHC funding. Unless your wife’s care needs have actually reduced and her scores in the review were genuinely lower, CHC should have remained in place. You can appeal if you feel the outcome was wrong.

Thank you for this article, it can be so difficult to find hard facts and your article states clearly how to prepare. I will be contacting social services and start the care account ready for next year. I cannot help thinking once £72,000 has been reached more blocks will be put in the way to receive any financial help or the Care Act will have changed!

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It takes you step-by-step through the whole NHS Continuing Healthcare process, right from the start, including how to approach the NHS, what should (and shouldn’t) happen, the pitfalls to avoid, what to do and say before, during and after an assessment, what’s right and what’s not, how to challenge decisions, how to pull apart the NHS’s assessment notes, etc.

It gives you a firm understanding of the process and lots of useful and practical information.

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